http://chriskresser.com/

Numerous environmental factors have been implicated in the development of autoimmune disease, including antibiotic use, birth by cesarean section, chemical exposure, poor diet, and sleep deprivation, among others (1, 2, 3, 4, 5). While it is widely believed that disease onset requires an environmental trigger, most autoimmune conditions have a genetic component as well (6).

Genetic information can be a powerful tool in aiding both diagnosis and treatment. One particular group of genes that has been strongly associated with various autoimmune diseases is HLA-B27. In this article, I’ll discuss HLA-B27, the role of a gut microbe called Klebsiella, and why a low-starch diet may be effective for those who have an HLA-B27-associated autoimmune disease.

What’s this about HLA?

HLA is short for human leukocyte antigen. “Leukocytes” are the white blood cells responsible for protecting your body from infection and foreign substances.  “Antigen” in this case refers to cell-surface proteins. Putting it together, HLA is essentially a group of genes that determine which proteins are present on the surface of your immune cells.

Humans have a total of 23 pairs of chromosomes, with one of each pair coming from each parent. You therefore inherit one set of HLA genes from your mother and one from your father, on the maternal and paternal versions of chromosome 6. HLA is a highly polymorphic gene, meaning there are many different possible gene set variants, or “haplotypes,” that you can have.

The astounding number of haplotypes for HLA likely evolved to allow for the fine-tuning of the human adaptive immune system, but certain haplotypes can also predispose an individual to a particular disease of the immune system. You may have read my previous article in which I mentioned the role of HLA haplotypes in susceptibility to mold illness. HLA-DQ haplotypes have also been associated with celiac disease (7), while HLA-DRB1 has been associated with rheumatoid arthritis (8). For the remainder of this article, I’ll focus on HLA-B27 and its connection to autoimmune disease.

The genetic link between autoimmune disease and dietary starch.

HLA-B27 is associated with various autoimmune diseases

The prevalence of HLA-B27 varies between ethnic groups and populations worldwide but is generally not a very common haplotype. Only 8 percent of Caucasians, 4 percent of North Africans, 2 to 9 percent of Chinese, and 0.1 to 0.5 percent of Japanese people possess HLA-B27 (9).

The most closely associated autoimmune disease with HLA-B27 is ankylosing spondylitis (AS), an inflammatory disease in which some of the vertebrae of the spine fuse together, inhibiting mobility. An estimated 88 percent of people with AS are HLA-B27 positive, yet only a fraction of HLA-B27-positive people will develop AS (10). Other autoimmune diseases that are associated with an HLA-B27 haplotype include Crohn’s disease, ulcerative colitis, psoriasis, reactive arthritis, and uveitis (11).

Making things a bit more complicated, HLA-B27 is itself polymorphic, with more than 100 different subtypes (12, 13). These are distinguished by a two-digit number added to the “parent” haplotype. Many of the most common subtypes of HLA-B27 (such as B2704 and B2705) are associated with increased risk of AS, while other subtypes (like HLA B2706 and B2709) actually appear to be protective against the disease (14, 15). This is likely due to the structure of the protein encoded by the HLA gene, as we’ll explore more in the next section.

The Klebsiella connection

As early as 1980, AS patients were identified as having elevated levels of serum IgA, suggesting the abnormal movement of microbes from the gut into the bloodstream (16). More recently, microbiome analyses identified greater abundance of a gram-negative bacterium called Klebsiella in stool samples of patients with AS (17). Fitting with their hypothesis of bacterial influx into the bloodstream, researchers found that these patients also had elevated levels of anti-Klebsiella antibodies in the blood (18).

Biochemical studies have found that Klebsiella have two molecules that carry sequences that closely resemble HLA-B27 (19, 20). Scientists have hypothesized that this “molecular mimicry” allows for cross-reactivity. In other words, the immune system produces antibodies against Klebsiella in an effort to remove it from the bloodstream, but these antibodies can also “accidentally” bind to HLA-B27. This idea of antibodies binding to “self” is characteristic of autoimmunity.

Although Klebsiella is one of the most widely studied microorganisms in relation to HLA-B27 and autoimmune disease, the concept of cross-reactivity applies to a number of different microbial (and dietary) antigens. For example, Proteus bacteria have been suggested to be involved in the development of rheumatoid arthritis via the same molecular mimicry mechanism as Klebsiella (21). As we’ll see next, knowledge of these mechanisms and the bacteria involved can really help shape our approach to treatment.

Why a low-starch diet might help

The composition of the gut microbiota is constantly shaped by the influx of dietary substrates (22), including proteins, fats, and carbohydrates. Within carbohydrates, substrates can be further categorized as simple sugars and polysaccharides like starch or cellulose.

Biochemical studies of Klebsiella have shown that this bacterium does not grow on cellulose derived from plants but can grow readily on more simple sugars (23). Most simple sugars like glucose are absorbed in the proximal small intestine and therefore do not travel as far as the large intestine, where the majority of microbes are located. Simple sugars from the diet are therefore unavailable to Klebsiella.

Starch, however, is not as easily digested or absorbed, and some of it remains intact when foodstuffs finally reach the colon. Klebsiella have been shown to manufacture pullulanase, a starch-debranching enzyme, that enables them to break down starch into simple sugars for energy and growth (24).

Several studies have applied this information in humans. One randomized control trial split people into two groups: a high-carbohydrate, low-protein diet or a low-carbohydrate, high-protein diet. They then compared the abundance of Klebsiella in fecal samples. The average number of Klebsiella was 30,000/gram in the high-carb group compared to 700/gram in the low-carb group (25). Another study found that a low-starch diet reduced total serum IgA in AS patients (26). The majority of these patients also reported a decline in symptom severity and, in some cases, complete remission.

Take steps toward remission

Now that you better understand the science behind HLA-B27-associated autoimmune disease, here are three things you can do to take action.

• Find out your haplotype
  Currently, there is no readily available, user-friendly means of determining HLA haplotype from full genomic sequencing data (from companies like 23andme). While there are a few HLA-related SNPs that can be identified in the raw genetic data, at best these are only correlated with HLA haplotype and do not provide information about subtype. The best and most accurate way to determine your haplotype is to request a blood test from your healthcare practitioner that uses a more targeted DNA sequencing approach to identify which alleles you carry (27).
• Experiment with your starch/carb intake
  Even if you don’t have access to genetic testing, or if you’re HLA-B27 negative, you can still do a self-experiment to see how you personally tolerate starch. I am a big proponent of n=1 experimentation and finding the diet that is right for you. Eileen Laird of Phoenix Helix has written an excellent post in which she shares the results of her own and several other Paleo autoimmune bloggers’ starch experiments. Many found that they can tolerate some forms of starch but not others. This is really valuable, since we know that a diet devoid of fermentable fiber like starch can be detrimental to the long-term health of the gut microbiota (28).
• Heal your gut
  At the risk of sounding like a broken record, healing the gut is absolutely critical to achieving and maintaining optimal health. A leaky gut allows bacteria and dietary proteins into the bloodstream, which provokes an immune response. Regardless of your HLA haplotype, strengthening the integrity of the intestinal barrier is an important step towards achieving remission. Supporting a diverse, healthy microbiota can also help to keep Klebsiella and other potentially problematic microbes at bay.

Now I’d like to hear from you. Do you know your HLA haplotype? Have you noticed a change in your autoimmune disease symptoms by increasing or decreasing your starch intake? Share your experience in the comments section below.

Originally posted at: http://www.nerdfitness.com/

What’s up all you party people! It’s that time of the month. (No, not that time of the month). It’s time to learn how to cook something new.

This time we’re going back to basics with our recipes with an easy peasy, Level One fajita recipe. With less than 10 ingredients, you’ll be done in 30 minutes. If you’re feelin’ hungry, and want to try something new and simple for dinner, you’ve come to the right place.

When you haven’t cooked in a while or you’re new to cooking, sometimes just one simple, delicious recipe can get you in the game. You start to cook that, maybe a few times within a couple of weeks, and then you find a more adventurous recipe. The effect keeps snowballing, and before you know, you’re regularly cooking a few times a week and have an array of recipes in your arsenal.

Fajitas were that door-opening recipe for me. They were one of the first things that I learned how to cook when I was beginning to fend for myself in the kitchen, and they still make an appearance in my regular dinner rotation. They’re delicious, they make great left-overs, plus they look fairly impressive if you’re having people over. Just look at those colors!

So today you’re going to learn the basics of this classic, go-to recipe for entertaining friends on movie night, game night, or whatever it is you crazy kids do for fun.

Enough chatter.

Let’s get to it!

Prep time: 15 minutes
Cook time: 15 minutes
Serves: 4-6

Ingredients:

• 1lb steak – flank or skirt steak works best. If you’re not a fan of beef or you’re on a budget, chicken thighs or breasts work great here too!
• 2 bell peppers – your choice of color
• 1 medium sized onion – I like red, but you can choose your favorite
• 2 tbsp olive oil (split into 1tbsp portions – one for marinade and one for cooking)
• juice from 2 lemons (or 3 limes)
• 1 tsp red chili powder
• 1/2 tsp garlic powder
• 1/8 tsp salt
• 1/8 tsp pepper

To serve:

• butter lettuce (or tortillas if you’re not feelin’ paleo or you have non-paleo guests)
• pico de gallo
• salsa
• avocado/guacamole
• cheese or sour cream (optional)

Equipment:

• cutting board
• knife
• mixing bowl
• fork
• skillet
• tongs

Instructions:

1. Make your sauce – Mix 1 tbsp of your olive oil with your lemon juice, red chile powder, garlic powder, salt, and pepper in a decently sized mixing bowl (you’re gonna put the steak in there too).

2. Slice your steak against the grain -This is probably the MOST IMPORTANT tip in this whole recipe, so listen up! Slicing your steak against the grain will allow the steak to be more tender and tasty. If you slice your steak the wrong way, you’ll end up with long, stringy, chewy, and damn near inedible steak bits. You can still eat the steak, but your jaw will get a hell of a workout, and you’ll be sad.

“I thought there were no grains in Paleo! What do you mean slice against the grain?!”

Take a look at that handsome hunk of beef on your cutting board. You’ll notice that there are a bunch of lines in the meat that are all facing the same direction. This is what is called the “grain”. You’re going to want to slice your meat perpendicular to those lines in the steak. Here’s what that’ll look like:

In addition to slicing the meat against the grain, you’ll also want to slice it pretty thin. This is because we’re cooking this particular meat in a pan. If you slice it thin, you’ll be able to easily see when it’s cooked through, and the meat cooks quickly if it’s cut thin. You’re hungry. I’m hungry. Let’s hurry up and eat already.

I’m not going to get sciencey on you. I’m here to cook. If you want a nerdy, in-depth exploration of meat slicing theory, check out this post from the wonderful Alton Brown.

3. Put those steak slices in the sauce and mix it well to coat. Go ahead and mix it with your hands. Don’t be shy. Just make sure you wash your hands after.

Cover with plastic wrap or a plate or nothing at all and place your bowl of meat in your fridge – if you’re good at thinking ahead and marinading your meat ahead of time, you can leave this marinading for up to 4 hours. If you’re a last minute meal planner like myself, just keep the meat in the marinade while you’re prepping your other ingredients. This is long enough to help tenderize the meat and give it some flavor.

Don’t let recipes that require marinating deter you! Even 15-30 minutes is better than nothing.

4. Wash your knife and cutting board very well or switch them out. This is important! Nobody wants to make themselves sick with cross contamination. Some people even suggest keeping separate cutting boards for veggies and meats. Not a totally crazy idea since you’ll be 100% sure you’re not getting raw meat goo on your veggies!

5. Slice your onions and peppers. Do it like this:

Peppers:

Onion:

Note: I chose my onion poorly. It was a flat tire/donut shape instead of a round/sphere shape. There wasn’t much for me to hold on to while cutting, which means my fingers and the knife were hanging out pretty close together as I was slicing. Choose a more spherical onion when you’re shopping for this recipe. You’ll have less of a chance of chopping your fingies. (It happens to the best of us – careful with that link if you’re squeamish.)

5. Heat up your skillet.

6. Once it’s hot, toss your veggies on the stove with 1tbsp olive oil. Cook 3-4 minutes until they’re a little bit soft and shiny. Remove from heat and set aside.

7. Let your skillet heat up again, and then toss your meat in. Now, don’t just dump the whole bowl of meat in the skillet. I did this and I ended up having to drain it – not hard, but always makes me go “uuuuugh”. Learn from my mistakes! Use your tongs to place it in there nicely. You’re not going to want to put that extra marinade in the pan or else your meat will sort of boil and take longer to cook.

Cook that for 5-10 minutes or until steak is cooked thoroughly. How do you know it’s cooked? It’ll change color from red/pink to brown.

8. Toss the veggies back in the pan and mix them up with the meat. (I probably should have used a bigger pan).

9. Serve on tortillas or butter lettuce cups with pico de gallo, salsa, guacamole, or whatever else your heart desires.

Ta da!

Crushin’ it!

You made some damn tasty fajitas that look beautiful! Pat yourself on the back. Take a bow. You rock!

If you want your fajitas spicier, try adding red pepper flake or a dash of cayenne pepper into the marinade. Or you can pour on the hot sauce as a topping when you’re assembling.

If you’re a vegetarian, eliminate the meat and use portobello mushrooms or tempeh.

Need more calories or a side dish? Serve with some beans and rice. Or try a Mexican cauliflower rice.

Now I know some of you seasoned cooks might be offended by the fact that I cooked this recipe in a pan. It is summer-time in the northern hemisphere and that’s prime grillin’ season.

But this recipe is intended for all you level 1 folks out there. (Yes, you.) It only takes about 30 minutes and uses a new cook’s most basic skill set (cutting and cooking stuff in a pan). If you want to grill your fajita meat and veggies, be my guest! I know it’s delicious, but unfortunately not all of us have access to a grill. Plus, for beginner chefs: the possibility of under or over cooking increases significantly when cooking over an open flame.

Veterans of the kitchen, what tips did I miss to make this meal tastier for newbies?

• Do you have a secret fajita sauce recipe?
• Do you add an unconventional vegetable to your line-up that’s out of this world?
• Do you use shrimp instead of beef or chicken?

Do you do something different with fajitas, or just have a question about the recipe? See you in the comments!

-Noel

https://www.girlsgonestrong.com/

Chronic pain can have far-reaching effects on a person, deeply affecting their overall quality of life and general health.

Chronic pain may cause a person to limit their activities, avoid movement, and decrease their social interactions. Many people with chronic pain often experience disturbances in mood, sleep disorders, and inability to function at the level required by everyday responsibilities like performing their work, or caring for their children or other family members.

What Is Pain?

What is pain? How does it start? Why does it persist? Why is it so hard to “get better” sometimes?

Pain is a complex experience, and the answers to these questions vary depending on the individual experiencing the pain. Everything from your beliefs to tissue damage you may have experienced initially will impact how you experience pain.

Pain can also occur without tissue damage. For example, a person may continue to experience pain, even when the original tissue damage (such as a broken bone or ligament sprain) has healed. Conversely, tissue damage can occur without the perception of pain. Have you ever looked down and noticed a huge bruise on your shin, but you don’t even remember getting hurt? You did not perceive pain, yet the tissue is clearly “damaged.”

Is Pain Real?

As one of my teachers, Dr. Jan Dommerholt (a renown expert in the physical therapy diagnosis and treatment of people with chronic pain) explains: “The pain is what the patient says it is, where they say it is, to the magnitude they say it is.”

The experience of pain is very real for a person going through it.

Your body constantly receives input from your nerves, sending messages up the spinal cord to the brain. The brain then makes decisions about whether it perceives a message as a threat. If it does, it can create a “danger” message (pain) to tell you to avoid that activity.

Professor Lorimer Moseley has an informative and engaging TEDx talk on this topic, and his book, Explain Pain (co-authored by Dr. David Butler, founder of the Neuro Orthopaedic Institute) can be very helpful for people experiencing pain, as well as for their loved ones.

What Is Chronic Pain?

Chronic pain is not prolonged acute pain. Chronic pain is typically defined as pain that lasts longer than three months, or past the time of normal tissue healing. Some of the most common chronic pain complaints include low back pain, arthritis pain, headaches, cancer pain, and nerve and muscle pain. Though not always the case, chronic pain could start with an injury or other specific cause, but lingers long after healing has occurred.

On the other hand, the onset of acute pain happens fairly quickly as the direct result of injury or trauma, disease, or inflammation, and is often accompanied by anxiety or emotional distress. This type of pain normally resolves when the cause is treated and healing takes place.¹

Chances are that you or someone you love is living with chronic pain. In fact, it is estimated that in the United States, nearly half of all adults experience chronic pain.

Based on a survey conducted by the CDC between 2001 and 2003, the overall prevalence of common, predominantly musculoskeletal pain conditions (such as arthritis, rheumatism, chronic back or neck problems, and frequent severe headaches) was estimated at 43 percent among adults in the U.S. Findings from a 2012 National Health Interview Study showed that 11.2 percent of adults report having daily pain.²

As a physical therapist, I work with people in pain every day. A major component of my treatment involves educating people about their pain, and ways that they can influence their behaviors around pain including gentle movement and addressing their thoughts and beliefs about their pain.

I first learned about the concept of pain science in 2011 from Dr. Dommerholt. I had treated people in pain for 19 years at that point, and I lacked a paradigm for explaining why some people had pain that continued even in the absence of tissue damage. I completed over 100 hours of classroom and practical education with Dr. Dommerholt and Dr. Robert Gerwin in an effort to understand pain science and the role of a physical therapist in the treatment of chronic pain.

What’s the most effective treatment—medication or education?

The effects of chronic pain can become extremely costly, both in terms of health care costs as well as the emotional and social impact that chronic pain has on a person’s life. Patients with chronic pain often find that they cannot continue to work the type of job they had before their pain began, and they may need to stop working. Many of my patients with chronic pain are on disability, and find that they can longer support their families. This leads to not only financial issues for the family, but also stress and discord, which in turn may increase the patient’s perception of their pain.

Historically, chronic pain has largely been treated with medication. However, in recent years, patient education has increasingly become a preferred approach to treatment by many medical professionals. In the last 10 years there has been increasing support for therapeutic neuroscience education from clinical trials, educational science, neuroscience, plain logic and the failure of drug therapy on chronic pain outcomes. Dr. David Butler said:

“It is no longer acceptable that pain be just managed. We must expect that it can be treated, and sufferers can alter it themselves through education.”

Medication

An estimated 20 percent of patients who go see a doctor about non-cancer pain symptoms or pain-related diagnoses (including acute and chronic pain) receive an opioid prescription. In 2012, health care providers wrote 259 million prescriptions for opioid pain medication—enough for every adult in the United States to have a bottle of pills! In 2013, based on diagnosis criteria outlined in the DSM-IV (fourth edition of the Diagnostic and Statistical Manual of Mental Disorders, a handbook used by healthcare professionals in the United States and much of the world to diagnose mental disorders), the Centers for Disease Control and Prevention (CDC) estimated that 1.9 million persons in the United States abused or were dependent on prescription opioid pain medication.³

In March 2016, after conducting a systematic review of the available scientific evidence, the CDC published new guidelines regarding the use of opiates for chronic pain. Upon review, the CDC concluded that there is limited evidence available on long-term opioid therapy for chronic pain, outside of end-of-life care, and thus, not enough evidence to determine long-term benefits of opioid therapy compared to no opioid therapy. Their findings also suggest there is a dose-dependent risk for serious harm.³

Education

In light of the new guidelines and the magnitude of the opioid epidemic in the U.S., the way we treat chronic pain must change. Evidence supports the use of education about pain science and the use of graded exposure to movement as part of the team approach to working with people experiencing chronic pain.

Treatment requires a team approach, and the person experiencing pain needs to be part of this team.

Treatment is generally most effective when it follows a biopsychosocial paradigm—this approach considers biological, psychological, and social factors and their complex interactions in understanding health, illness, and health care delivery.⁴ Because pain is the result of many factors, we cannot just address one factor in treatment. The experience of pain will vary from person to person, based on many factors such as the person’s thoughts, attitudes, and beliefs about pain, as well as tissue damage and healing process.

Pain science patient education aims to help patients significantly change their pain beliefs, attitudes, and physical performance. Dr. David Butler and Prof. Lorimer Moseley, leading researchers in the area of pain science, explain that pain is not necessarily a sign of damage, but more of an individual’s response to threat, real or perceived.⁵ Their research shows that when we teach a patient to understand their body and its signals, and to gain confidence in their movement, therapists help that patient reduce the stress responses that occur in their body when they think about experiencing pain.

One aspect of treatment that a physical therapist will utilize when working with a person in pain is graded exposure to movement. That is, gradual performance of tasks that previously set off alarm messages in the brain. Through a gradual progression of previously feared activities, a patient can increase their threshold of movement. For example, if a person experiences pain when bending forward, we gradually increase their tolerance of bending forward to achieve their goal of being able to tie their own shoes again.

Our beliefs about our injury and our pain are often incorrect. The authors of Explain Pain have devised an easy-to-understand way to talk about beliefs as they relate to pain. They refer to these beliefs as “thought viruses,” or “Danger in Me” messages, that become part of our belief system. The belief that “movement is dangerous” is an example of a thought virus, and this belief can cause a patient to begin to severely limit their activities. Lack of movement can lead to a host of other health issues over time. Knowledge, on the other hand, can be a “thought vaccine,” or a “Safety in Me” message.⁵ When we question the validity of our limiting beliefs about pain, we can begin to improve our quality of life and our function. This short video explains thought viruses in an easy-to-understand format.

The experience of pain is very real for the person going through it, and many factors, including their beliefs and their environment, can affect that experience.

Working with knowledgeable and compassionate medical professionals, and having the support and understanding of friends, family, and colleagues can make a great difference in their progress.

If you are living with chronic pain (or know someone who is), please take a look at all of the resources mentioned in this article, and find a physical therapist who will partner with you, empowering you to reach your goals for a more active life.

Additional Resources

• Danger In Me, Safety In Me
• Lorimer Moseley TEDx Talk
• Thought Viruses
• Thought Viruses Video (YouTube)
• Find a physical therapist
•  Explain Pain by Dr. David Butler and Prof. Lorimer Moseley

Dealing with an injury or chronic pain can be frustrating and scary. You feel helpless and out of control, and just want your body to function like it used to.

GET THE MODERN WOMAN’S INJURY PREVENTION HANDBOOK FOR JUST $17

References

1. Chronic Pain: Symptoms, Diagnosis, & Treatment. NIH MedlinePlus: A publication of the National Institutes of Health and the Friends of the National Library of Medicine. 2011(6)1:4-6
   https://medlineplus.gov/magazine/issues/spring11/articles/spring11pg4.html https://medlineplus.gov/magazine/issues/spring11/articles/spring11pg5-6.html
2. National Health Interview Survey. Centers for Disease Control. http://www.cdc.gov/nchs/nhis/
3. Dowell D, Haegerich TM, Chou R. CDC Guideline for Prescribing Opioids for Chronic Pain — United States, 2016. MMWR Recomm Rep 2016;65(No. RR-1):1–49.   http://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm
4. The Biopsychosocial Approach. University of Rochester Medical Center https://www.urmc.rochester.edu/medialibraries/urmcmedia/education/md/documents/biopsychosocial-model-approach.pdf
5. Butler D, Moseley L. Evidence base for Explain Pain Second Edition. Noigroup Publications, Adelaide, south Australia. 2013 http://www.noigroup.com/documents/noi_explain_pain_2nd_edn_evidence_base_0813.pdf

The post What You Must Know About Chronic Pain appeared first on Girls Gone Strong.

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Russia faces a countrywide ban from this summer’s Olympics after evidence has emerged of a four-year state-sponsored doping program.

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Preparing for endurance events requires a great deal of time and effort. Typically, athletes use long slow distance (LSD) training in an effort to boost their aerobic system as much as possible before a race. There is no real substitute for improving the aerobic system than LSD training, and a strong aerobic fitness will directly translate to better times on the course.

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http://www.thealternativedaily.com/

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